학술논문
How Can We Diagnose Pre-malignant Solitary Cecal Ulcer?/Pre-malign Soliter Cekal Ulseri Nasil Taniriz?
CASE REPORT
CASE REPORT
Document Type
Case study
Source
Turkish Journal of Colorectal Disease. March 2018, Vol. 28 Issue 1, p37, 3 p.
Subject
Language
English
ISSN
2536-4898
Abstract
Introduction Uncomplicated solitary cecal ulcer is usually diagnosed during laparotomy, even though colonoscopy is the best diagnostic method. The first condition considered in the differential diagnosis of cecal ulcer is [...]
A 75-year-old woman presented with a 1-month history of right lower quadrant pain and constipation. Physical examination revealed tenderness to palpation. The patient had no history of inflammatory bowel disease. The colonoscopy displayed marked partial obstruction of the cecum with a large ulcerated area and surrounding friable epithelium in the medial cecal region. Microscopic evaluation of the biopsy specimens revealed an acute ulcer with granulation tissue and overlying fibrinopurulent debris. There was no evidence of granulomatous inflammation or crypt abscesses suggesting inflammatory bowel diseases, except the atypical epithelial cells. Additionally, abdominopelvic tomography showed a suspicious cecal tumor underlying a thickened bowel wall and mesocolic lymph adenopathy. Subsequently, we performed right hemicolectomy due to clinical obstruction. No complications were observed during postoperative follow-up. The pathology result confirmed cecal ulcer with low-grade dysplasia. Keywords: Solitary cecal ulcer, dysplasia, colonoscopy, hemicolectomy Yetmis bes yasinda kadin hasta, bir aydir olan ve giderek artan sag alt kadran agrisi ve kabizlik sikayetiyle acil servisimize basvurdu. Fizik muayenede sag alt kadranda hassasiyet tespit edildi. Batin bilgisayarli tomografi goruntulemesi ise sag kolonda oncelikle kolon kanseri ile uyumlu duvar kalinlasmasi oldugunu ve mezenterik yag dokusu icinde birkac adet lenf nodu oldugunu saptadi. Hem klinik hem de radyolojik bulgularda kolon kanseri suphesi olmasi nedeniyle hastaya kolonoskopi yapildi. Cekumda parsiyel tikanikliga yol acan genis tabanli ulser saptandi. Alinan biyopsinin sonucu atipik epitel fragmanlariyla beraber ulser ve ulser zemininde enflamatuvar debris olarak degerlendirildi. Hastaya sag hemikolektomi yapildi. Patoloji degerlendirmesinde submukozaya sinirli ulser, enflamatuvar lenf nodlari ve mukoza epitelinde hafif displazi tespit edildi. Postoperatif donemde takiplerinde sorun izlenmedi. Anahtar Kelimeler: Soliter cekal ulser, displazi, kolonoskopi, hemikolektomi
A 75-year-old woman presented with a 1-month history of right lower quadrant pain and constipation. Physical examination revealed tenderness to palpation. The patient had no history of inflammatory bowel disease. The colonoscopy displayed marked partial obstruction of the cecum with a large ulcerated area and surrounding friable epithelium in the medial cecal region. Microscopic evaluation of the biopsy specimens revealed an acute ulcer with granulation tissue and overlying fibrinopurulent debris. There was no evidence of granulomatous inflammation or crypt abscesses suggesting inflammatory bowel diseases, except the atypical epithelial cells. Additionally, abdominopelvic tomography showed a suspicious cecal tumor underlying a thickened bowel wall and mesocolic lymph adenopathy. Subsequently, we performed right hemicolectomy due to clinical obstruction. No complications were observed during postoperative follow-up. The pathology result confirmed cecal ulcer with low-grade dysplasia. Keywords: Solitary cecal ulcer, dysplasia, colonoscopy, hemicolectomy Yetmis bes yasinda kadin hasta, bir aydir olan ve giderek artan sag alt kadran agrisi ve kabizlik sikayetiyle acil servisimize basvurdu. Fizik muayenede sag alt kadranda hassasiyet tespit edildi. Batin bilgisayarli tomografi goruntulemesi ise sag kolonda oncelikle kolon kanseri ile uyumlu duvar kalinlasmasi oldugunu ve mezenterik yag dokusu icinde birkac adet lenf nodu oldugunu saptadi. Hem klinik hem de radyolojik bulgularda kolon kanseri suphesi olmasi nedeniyle hastaya kolonoskopi yapildi. Cekumda parsiyel tikanikliga yol acan genis tabanli ulser saptandi. Alinan biyopsinin sonucu atipik epitel fragmanlariyla beraber ulser ve ulser zemininde enflamatuvar debris olarak degerlendirildi. Hastaya sag hemikolektomi yapildi. Patoloji degerlendirmesinde submukozaya sinirli ulser, enflamatuvar lenf nodlari ve mukoza epitelinde hafif displazi tespit edildi. Postoperatif donemde takiplerinde sorun izlenmedi. Anahtar Kelimeler: Soliter cekal ulser, displazi, kolonoskopi, hemikolektomi